A shift of syphilis infections into the heterosexual population and an increase in the use of injection drugs in Manitoba have resulted in a dramatic increase in the number of babies treated for the disease in the past six months, acting chief provincial public health officer Dr. Michael Isaac said at a news conference in Winnipeg Feb. 25.
“Syphilis cases have been rising in Manitoba over the past five years, from 118 cases in 2014 to more than 350 cases in 2018,” Isaac said. “The increase in women infected is noteworthy, rising from 16 in 2014 to 168 in 2018. This is of particular concern because historically when cases increase in women cases of syphilis in newborns increase as well and this has unfortunately occurred in Manitoba with more than 10 infants treated for congenital syphilis in the past six months.”
Most of those suspected cases of congenital syphilis – when the infection is passed from a pregnant mother to her baby – have occurred in either the Winnipeg Regional Health Authority or the Northern Regional Health Authority but syphilis is present across the province and there have been cases outside of those regions. Some of the infants were treated as a precaution.
“Some of those infants that have been treated in the past six months had signs and symptoms of congenital syphilis and some didn’t,” Isaac said. “If the mother had acquired syphilis in pregnancy but was not treated adequately then the baby, once it was born, would be treated at that point in time as a precautionary reason.”
There was only one congenital syphilis case in 2015 and one case in 2017. Prior to that, Isaac said, there hadn’t been a case of congenital syphilis in Manitoba for years.
Other jurisdictions, including Alberta, Quebec and Newfoundland have also seen increases in congenital syphilis cases and the Centre for Disease Control and Prevention in the United States is reporting the highest rates of congenital syphilis in decades.
Complications of congenital syphilis can include miscarriage, stillbirth, premature birth, low birth weight and death shortly after birth. Babies born with syphilis may have deformed bones, jaundice, brain and nerve problems like blindness or deafness, meningitis and skin rashes
“We noticed in late 2018 and early 2019 a large increase in cases of congenital syphilis, especially the last six weeks, so the risk level has changed and we wanted to make sure that providers and the public know about that,” said Isaac. “Some of the risk factors that we’ve identified is that in about 70 per cent of the congenital cases the moms were using substances or injecting drugs and also 30 per cent didn’t have prenatal care so there is definitely a population that we’re not reaching that we need to do a better job reaching in terms of trying to access prenatal care and providing good harm reduction services to them. Having said that, we have had cases of congenital syphilis where those risk factors did not exist.”
At least one syphilis test is standard during a pregnancy in Manitoba and the rest of Canada, Isaac said.
Prior to the current syphilis outbreak, which began in 2014, syphilis was more prevalent among men who have sex with men, but now it is increasingly being seen among heterosexual couples.
Syphilis is caused by bacteria and easily treatable. An infant born with congenital syphilis would be admitted to hospital and usually given a 10-day course of penicillin, said Isaac, while an adult can be treated with just a single injection of long-acting penicillin.
“Fortunately there is no resistance to penicillin in the syphilis that we’ve been seeing in North America so we still have very good treatments for it,” he said.
Manitoba Health, Seniors and Active Living is collaborating with the federal First Nations and Inuit Health Branch and tribal councils to get the world out in First Nations communities.
Syphilis is contracted from sores on the genitals or elsewhere and the province says using condoms and being in a long-term monogamous relationship with someone who has been tested for syphilis and doesn’t have it are the most effective preventions.
Syphilis is not the only sexually transmitted infection that is on the rise in recent years in Manitoba.
“Our gonorrhea rates are up, our hepatitis C rates are up, so there certainly is a high amount of disease out there right now and again we need to have good provincial response to work with stakeholders and try and get it under control,” Isaac said.
The Thompson Citizen’s inquiries to the public health department regarding how many babies have been treated for congenital syphilis in the NRHA and how many cases of syphilis in adults that the region has seen have not yet been answered.
